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    1. Deep Learning–Based Automated Optical Coherence Tomography Segmentation in Clinical Routine: Getting Closer

      Deep Learning–Based Automated Optical Coherence Tomography Segmentation in Clinical Routine: Getting Closer

      Recently, many ophthalmologists have heard the keywords artificial intelligence , machine learning , deep learning , and automatization at every conference and keynote lecture and seen them in every ophthalmology journal. 1 Many studies 1 have evaluated the use of such algorithms on large retrospective data sets—primarily on color fundus photographs at first, then on optical coherence tomography (OCT) images as well. Most of these have been study data sets with standardized and well-structured imaging protocols and reading center image collections with a predefined protocol, and therefore of good quality. However, how functional will algorithms be in a busy clinical routine? Can ...

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    2. Validation and Clinical Applicability of Whole-Volume Automated Segmentation of Optical Coherence Tomography in Retinal Disease Using Deep Learning

      Validation and Clinical Applicability of Whole-Volume Automated Segmentation of Optical Coherence Tomography in Retinal Disease Using Deep Learning

      Importance: Quantitative volumetric measures of retinal disease in optical coherence tomography (OCT) scans are infeasible to perform owing to the time required for manual grading. Expert-level deep learning systems for automatic OCT segmentation have recently been developed. However, the potential clinical applicability of these systems is largely unknown. Objective: To evaluate a deep learning model for whole-volume segmentation of 4 clinically important pathological features and assess clinical applicability. Design, setting, participants: This diagnostic study used OCT data from 173 patients with a total of 15 558 B-scans, treated at Moorfields Eye Hospital. The data set included 2 common OCT devices ...

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    3. Comparison of Central Macular Fluid Volume With Central Subfield Thickness in Patients With Diabetic Macular Edema Using Optical Coherence Tomography Angiography

      Comparison of Central Macular Fluid Volume With Central Subfield Thickness in Patients With Diabetic Macular Edema Using Optical Coherence Tomography Angiography

      Importance: Diabetic macular edema (DME) is the predominant cause of visual impairment in patients with type 1 or 2 diabetes. Automated fluid volume measurements using optical coherence tomography (OCT) may improve the diagnostic accuracy of DME screening. Objective: To assess the diagnostic accuracy of an automated central macular fluid volume (CMFV) quantification using OCT for DME. Design, setting, and participants: A cross-sectional observational study was conducted at a tertiary academic center among 215 patients with diabetes (1 eye each) enrolled from January 26, 2015, to December 23, 2019. All participants underwent comprehensive examinations, 6 × 6-mm macular structural OCT horizontal raster ...

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    4. Understanding Visual Acuity Outcomes After Retinal Detachment Repair by Assessing Photoreceptor Integrity on Spectral-Domain Optical Coherence Tomography

      Understanding Visual Acuity Outcomes After Retinal Detachment Repair by Assessing Photoreceptor Integrity on Spectral-Domain Optical Coherence Tomography

      The annual incidence of rhegmatogenous retinal detachment is approximately 18 to 22 per 100 000 population1,2 and reported techniques for reattaching the retina include pneumatic retinopexy (PnR), scleral buckle, and pars plana vitrectomy (PPV). Recently, it has become increasingly common to repair a retinal detachment using vitrectomy and gas, given the higher anatomical success rate of this procedure. However, the Pneumatic Retinopexy Versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT) showed that even though the anatomical success of PnR is lower than that of PPV, visual acuity outcomes were better and rates ...

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    5. Preterm Infant Stress During Handheld Optical Coherence Tomography vs Binocular Indirect Ophthalmoscopy Examination for Retinopathy of Prematurity

      Preterm Infant Stress During Handheld Optical Coherence Tomography vs Binocular Indirect Ophthalmoscopy Examination for Retinopathy of Prematurity

      Importance: Binocular indirect ophthalmoscopy (BIO) examination for retinopathy of prematurity (ROP) is a well-known cause of repeated preterm infant stress. Objective: To compare stress during investigational optical coherence tomography (OCT) imaging to that during BIO for ROP. Design, setting, and participants: This cross-sectional study examined infants at the bedside in the intensive care nursery. Consecutive preterm infants enrolled in Study of Eye Imaging in Preterm Infants (BabySTEPS) who had any research OCT imaging as part of the study. Patients were recruited from June to November 2019, and analysis began April 2020. Main outcomes and measures: Infant stress was measured using ...

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    6. Longitudinal Assessment of Retinal Thinning in Adults With and Without Sickle Cell Retinopathy Using Spectral-Domain Optical Coherence Tomography

      Longitudinal Assessment of Retinal Thinning in Adults With and Without Sickle Cell Retinopathy Using Spectral-Domain Optical Coherence Tomography

      Importance: Determination of retinal thinning rates may help to identify patients who are at risk of progression of sickle cell retinopathy. Objective: To assess the rates of macular thinning in adults with and without sickle cell retinopathy using spectral-domain optical coherence tomography (OCT) and to identify ocular and systemic risk factors associated with retinal thinning. Design, setting, and participants: This longitudinal prospective case-control study enrolled adult participants from a university-based retina subspecialty clinic between February 11, 2009, and July 3, 2019. The study was designed in autumn 2008 and conducted from February 2, 2009, to July 3, 2020. Participants with ...

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    7. Association of Optical Coherence Tomography With Longitudinal Neurodegeneration in Veterans With Chronic Mild Traumatic Brain Injury

      Association of Optical Coherence Tomography With Longitudinal Neurodegeneration in Veterans With Chronic Mild Traumatic Brain Injury

      Importance: Mild traumatic brain injury (TBI) may predispose individuals to progressive neurodegeneration. Objective: To identify evidence of neurodegeneration through longitudinal evaluation of changes in retinal layer thickness using optical coherence tomography in veterans with a history of mild TBI. Design, setting, and participants: This longitudinal cohort study evaluated veterans who were receiving services at the Minneapolis Veterans Affairs Health Care System. Symptomatic or mild TBI was diagnosed according to the Mayo TBI Severity Classification System. Participants in the age-matched control group had no history of TBI. Participants with any history or evidence of retinal or optic nerve disease that could ...

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    8. Interaction Between the Distribution of Diabetic Retinopathy Lesions and the Association of Optical Coherence Tomography Angiography Scans With Diabetic Retinopathy Severity

      Interaction Between the Distribution of Diabetic Retinopathy Lesions and the Association of Optical Coherence Tomography Angiography Scans With Diabetic Retinopathy Severity

      Importance Studies have not yet determined whether the distribution of lesions in the retinal periphery alters the association between the severity of diabetic retinopathy (DR) and macular vessel density. Objective To evaluate the association of DR lesion distribution with optical coherence tomography angiography (OCTA) metrics and DR severity. Design, Setting, and Participants This cross-sectional observational study was conducted at a tertiary care center for diabetic eye disease among 225 patients with type 1 or 2 diabetes who had undergone imaging between February 15, 2016, and December 31, 2019. Exposures Optical coherence tomography angiography 3 × 3-mm macular scans and ultra-widefield color ...

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    9. Using Optical Coherence Tomography as a Surrogate of Measurements of Intracranial Pressure in Idiopathic Intracranial Hypertension

      Using Optical Coherence Tomography as a Surrogate of Measurements of Intracranial Pressure in Idiopathic Intracranial Hypertension

      Importance There is an unmet need for noninvasive biomarkers of intracranial pressure (ICP), which manifests as papilledema that can be quantified by optical coherence tomography (OCT) imaging. Objective To determine whether OCT of the optic nerve head in papilledema could act as a surrogate measure of ICP. Design, Setting, and Participants This longitudinal cohort study used data collected from 3 randomized clinical trials that were conducted between April 1, 2014, and August 1, 2019. Participants who were female and had active idiopathic intracranial hypertension were enrolled from 5 National Health Service hospitals in the UK. Automated perimetry and OCT imaging ...

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    10. Diagnosis and Grading Of Papilledema Using Optical Coherence Tomography Compared To Clinical Staging By Frise´n Scale

      Diagnosis and Grading Of Papilledema Using Optical Coherence Tomography Compared To Clinical Staging By Frise´n Scale

      Objectives To compare and contrast 2 methods of quantitating papilledema, namely, optical coherence tomography (OCT) and Modified Frisén Scale (MFS). Methods Digital optic disc photographs and OCT fast retinal nerve fiber layer (RNFL) thickness, fast RNFL map, total retinal thickness, and fast disc images were obtained in 36 patients with papilledema. Digital optic disc photographs were randomized and graded by 4 masked expert reviewers using the MFS. We performed Spearman rank correlations of OCT RNFL thickness, OCT total retinal thickness, and MFS grade from photographs. Results OCT RNFL thickness and MFS grade from photographs correlated well ( R = 0.85 ...

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    11. Progression of Photoreceptor Degeneration in Geographic Atrophy Secondary to Age-related Macular Degeneration

      Progression of Photoreceptor Degeneration in Geographic Atrophy Secondary to Age-related Macular Degeneration

      Importance Sensitive outcome measures for disease progression are needed for treatment trials in geographic atrophy (GA) secondary to age-related macular degeneration (AMD). Objective To quantify photoreceptor degeneration outside regions of GA in eyes with nonexudative AMD, to evaluate its association with future GA progression, and to characterize its spatio-temporal progression. Design, Setting, and Participants Monocenter cohort study (Directional Spread in Geographic Atrophy [ NCT02051998 ]) and analysis of data from a normative data study at a tertiary referral center. One hundred fifty-eight eyes of 89 patients with a mean (SD) age of 77.7 (7.1) years, median area of GA of ...

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    12. Model-to-Data Approach for Deep Learning in Optical Coherence Tomography Intraretinal Fluid Segmentation

      Model-to-Data Approach for Deep Learning in Optical Coherence Tomography Intraretinal Fluid Segmentation

      Importance Amid an explosion of interest in deep learning in medicine, including within ophthalmology, concerns regarding data privacy, security, and sharing are of increasing importance. A model-to-data approach, in which the model itself is transferred rather than data, can circumvent many of these challenges but has not been previously demonstrated in ophthalmology. Objective To determine whether a model-to-data deep learning approach (ie, validation of the algorithm without any data transfer) can be applied in ophthalmology. Design, Setting, and Participants This single-center cross-sectional study included patients with active exudative age-related macular degeneration undergoing optical coherence tomography (OCT) at the New England ...

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      Mentions: Tufts University
    13. Association of Optical Coherence Tomography Angiography Metrics With Detection of Impaired Macular Microvasculature and Decreased Vision in Amblyopic Eyes

      Association of Optical Coherence Tomography Angiography Metrics With Detection of Impaired Macular Microvasculature and Decreased Vision in Amblyopic Eyes

      Importance Microvascular abnormalities in amblyopia are becoming evident with high-resolution imaging, such as optical coherence tomography angiography (OCT-A); however, to our knowledge, the clinical significance and use of these findings are unknown. Objective To assess changes in quantitative OCT-A metrics in amblyopic eyes and explore their association with visual acuity in children. Design, Setting, and Participants This population-based nested case-control study included children aged 6 to 8 years who were consecutively recruited between January 2016 and July 2017 from the population-based Hong Kong Children Eye Study (HKCES) at the Chinese University of Hong Kong Eye Centre. All participants underwent OCT-A ...

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    14. Optical Coherence Tomography Angiography as an Important Diagnostic Tool for Amblyopia

      Optical Coherence Tomography Angiography as an Important Diagnostic Tool for Amblyopia

      Amblyopia has been a diagnosis of exclusion. Besides best-corrected visual acuity, there are presently no standardized metrics that are used for the diagnosis and evaluation of amblyopia. For more than a decade, studies using structural optical coherence tomography (OCT) had identified several differences between amblyopic and control eyes. 1 Qualitatively, the increase in height of the ellipsoid zone at the central fovea was noted to be attenuated or absent in 60% of amblyopic eyes compared with 29% of normal eyes. 2 Several studies had reported that the foveal minimum thickness was greater in amblyopic eyes compared with normal controls, but ...

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    15. Association of Intravitreal Aflibercept With Optical Coherence Tomography Angiography Vessel Density in Patients With Proliferative Diabetic Retinopathy: A Secondary Analysis of a Randomized Clinical Trial

      Association of Intravitreal Aflibercept With Optical Coherence Tomography Angiography Vessel Density in Patients With Proliferative Diabetic Retinopathy: A Secondary Analysis of a Randomized Clinical Trial

      Importance Although previous studies have evaluated the association between anti–vascular endothelial growth factor therapy and macular vessel density, they were confounded by the presence of macular edema, which may be associated with artifacts and segmentation errors in optical coherence tomography angiography (OCTA). Objective To evaluate the association of intravitreal aflibercept with changes in macular vascular density using OCTA in patients with proliferative diabetic retinopathy without diabetic macular edema. Design, Setting, and Participants This post hoc analysis of a randomized clinical trial used data on 40 eyes of 40 patients with proliferative diabetic retinopathy without diabetic macular edema who were ...

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    16. Steps Forward in Analyzing Optical Coherence Tomography in Age-Related Macular Degeneration—Capitalizing on the Power of Artificial Intelligence

      Steps Forward in Analyzing Optical Coherence Tomography in Age-Related Macular Degeneration—Capitalizing on the Power of Artificial Intelligence

      Imaging of the retina, originally by stereoscopic fundus photography and later by optical coherence tomography (OCT), has been essential to the diagnosis and monitoring of progression of age-related macular degeneration. Manual grading of color photographs acquired during the Age-Related Eye Disease Study to detect and quantify drusen and pigmentary changes led to a detailed severity scale that stratified 5-year risk of late AMD into 9 categories, with risk estimates ranging from 1% to 50%. 1 The high resolution of spectral-domain OCT now allows visualization of the retinal microanatomy. Drusen and focal areas of hyperpigmentation are associated with specific findings on ...

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    17. Characterization of Drusen and Hyperreflective Foci as Biomarkers for Disease Progression in Age-Related Macular Degeneration Using Artificial Intelligence in Optical Coherence Tomography

      Characterization of Drusen and Hyperreflective Foci as Biomarkers for Disease Progression in Age-Related Macular Degeneration Using Artificial Intelligence in Optical Coherence Tomography

      Importance The morphologic changes and their pathognomonic distribution in progressing age-related macular degeneration (AMD) are not well understood. Objectives To characterize the pathognomonic distribution and time course of morphologic patterns in AMD and to quantify changes distinctive for progression to macular neovascularization (MNV) and macular atrophy (MA). Design, Setting, and Participants This cohort study included optical coherence tomography (OCT) volumes from study participants with early or intermediate AMD in the fellow eye in the HARBOR (A Study of Ranibizumab Administered Monthly or on an As-needed Basis in Patients With Subfoveal Neovascular Age-Related Macular Degeneration) trial. Patients underwent imaging monthly for ...

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    18. Bilateral Enlargement of the Foveal Avascular Zone on Optical Coherence Tomography Angiography Associated With Cocaine Use

      Bilateral Enlargement of the Foveal Avascular Zone on Optical Coherence Tomography Angiography Associated With Cocaine Use

      Cocaine is a well-known cause of vascular injury and secondary end-organ damage. The presented case demonstrates retinal vascular abnormalities associated with a history of cocaine use in the absence of other retinal disease. A 61-year-old Latino man was referred for evaluation of gradual worsening near visual acuity and an inability to find a satisfactory refraction. His best-corrected visual acuity was 20/30 in each eye. Optical coherence tomography demonstrated bilateral inner retinal atrophy with disruption of the inner retinal layers and effacement of the foveal contour ( Figure 1 ). These changes spanned multiple vascular distributions. Fluorescein angiogram showed an enlarged foveal ...

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    19. Visualization of the Human Intracranial Vasa Vasorum In Vivo Using Optical Coherence Tomography

      Visualization of the Human Intracranial Vasa Vasorum In Vivo Using Optical Coherence Tomography

      The vasa vasorum are a specialized microvasculature that mainly arise from the adventitia and traverse the intimomedial layer of large arteries and veins. These are felt to serve as crucial routes of the delivery for trophic and nutritive factors, as well as regulatory signals. 1 Importantly, they also play a role in pathology via proliferation in atherosclerotic and hypertrophic intimomedia, as well as plaque hemorrhage and dissection via rupture. 2 In the setting of symptomatic vertebral artery stenosis, we report what is, to our knowledge, the first known in vivo visualization of the human native intracranial arterial vasa vasorum and ...

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    20. Reversal of Cupping in an Infant, Shown by Optical Coherence Tomography

      Reversal of Cupping in an Infant, Shown by Optical Coherence Tomography

      A 10-month-old white male infant with primary congenital glaucoma underwent successful goniotomy in the right eye, lowering intraocular pressure from 34 mm Hg to 11 mm Hg and decreasing axial length from 23.4 mm to 22.8 mm. We used optical coherence tomography (HRA+OCT Spectralis with Flex module [Heidelberg Engineering]) to image the optic nerve preoperatively and at 1 month postoperatively. The cup-disc ratio decreased from 0.6 to 0.4. The reversal of cupping was associated with decreased cup depth and an anterior shift of the Bruch membrane on optical coherence tomography ( Figure ). Notably, the preoperative and ...

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    21. Anterior Segment Optical Coherence Tomography Angiography of Iris Neovascularization After Intravitreal Ranibizumab and Panretinal Photocoagulation

      Anterior Segment Optical Coherence Tomography Angiography of Iris Neovascularization After Intravitreal Ranibizumab and Panretinal Photocoagulation

      A 58-year-old Japanese man with diabetes presented with blurred vision in his right eye. His intraocular pressure was 53 mm Hg and the peripheral anterior synechia index was around 20%. The anterior segment optical coherence tomography (OCT) angiography image showed that the iris neovascularization was marked around the pupil in the superficial layer ( Figure , A; green shading). 1 Anterior segment OCT angiography using a swept-source OCT system enabled the visualization of physiological radial vessels in the stroma, even in a brown eye ( Figure , A; red shading). Panretinal photocoagulation was administered immediately and completed in 3 separate installments over 1 month ...

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    22. Quantitative Microvascular Analysis With Wide-Field Optical Coherence Tomography Angiography in Eyes With Diabetic Retinopathy

      Quantitative Microvascular Analysis With Wide-Field Optical Coherence Tomography Angiography in Eyes With Diabetic Retinopathy

      Importance Wide-field optical coherence tomographic angiography (OCTA) may provide insights to peripheral capillary dropout in eyes with diabetic retinopathy (DR). Objective To describe the diagnostic performance of wide-field OCTA with and without large vessel removal for assessment of DR in persons with diabetes. Design, Setting, and Participants This case-control study was performed from April 26, 2018, to April 8, 2019, at a single tertiary eye center in Singapore. Case patients were those with type 2 diabetes for more than 5 years and bilateral DR diagnosed by fundus imaging; control participants included those with no self-reported history of diabetes, a fasting ...

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